Mitral valve repair and replacement surgery

If you were diagnosed with mitral valve disease, surgery is a solution often needed to manage the condition. Mitral valve repair and mitral valve replacement are the most common procedures used to fix damaged or diseased mitral valves.

The cardiac surgeons at Penn Medicine’s Heart Valve Disease Program perform the most mitral valve surgeries in Pennsylvania, restoring the function of affected mitral valves with a repair rate of nearly 100 percent - far above the national average. At Penn, patients experience care with access to state-of-the-art operating rooms and the latest advancements in minimally invasive surgery.

Whenever possible, surgeons at Penn Medicine repair mitral valves instead of replacing them. Repairing the mitral valve avoids complications that may occur when the valve is replaced with a prosthetic valve.

Our skilled surgeons use many techniques to repair your valve:

• Ring annuloplasty: The surgeon sews a ring (made of metal, cloth or tissue) around the valve to tighten or stabilize the repair.
• Valve leaflet repair: The surgeon alters your mitral valve leaflets by trimming, patching, shaping or rebuilding them so that they close tightly.
• Artificial chords: The surgeon incorporates artificial chords, which connect valve leaflets to the heart muscle, to support the leaflet and allow it to function normally.

If mitral valve repair is not an option or if your valve is narrowed from mitral valve stenosis, cardiac surgeons can replace your valve surgically. In the procedure, your doctor removes the diseased valve and replaces it with either a:

• Mechanical valve: The mitral valve is replaced with a man-made valve. To prevent blood clots that may accompany a mechanical valve, your doctor may prescribe blood-thinning medications.
• Biological valve: The replacement valve is made from cow, pig or human heart tissue. These valves may wear out over time, requiring another valve replacement.

Eligibility for mitral valve surgery depends on several different factors, including the severity of the mitral valve disease and your heart’s current condition. This largely varies from patient to patient.

Patients may be a good candidate for valve repair or replacement if they:

• Are diagnosed with mitral valve disease, like regurgitation, prolapse, or stenosis
• Are experiencing noticeable symptoms from their condition
• Do not smoke
• Do not have a body mass index (BMI) over 30, qualifying them as clinically obese
• Do not have a history of other heart conditions such as coronary artery disease (CAD) and aortic valve disease

Other options exist for patients that do not qualify for a surgical replacement of the mitral valve:

• Transcatheter mitral valve replacement (TMVR): This minimally invasive, catheter-based procedure uses a tube to guide a new valve to your heart.
• MitraClip™: This procedure uses a mitral valve clip to secure leaky valves. This may be recommended for those with regurgitation that are not eligible for mitral valve surgery.

Most patients living with valve insufficiency and leakage are eligible for valve repair, which tends to offer benefits over replacement like lower risk, less maintenance, and faster recovery.

Your mitral valve repair or replacement will either be performed using open-heart surgery or minimally invasive heart surgery. Whenever possible, our expert surgeons will operate on your mitral valve using robotic-assisted surgery — a newer approach to minimally invasive procedures.

Valve surgery at Penn takes place in state-of-the-art operating rooms. During your valve repair or replacement:

• One of our expert cardiac anesthesiologists will administer general anesthesia and ensure that you are sleeping comfortably during the procedure.
• Our cardiac team will place you on a heart-lung bypass machine, which pumps blood through your body during the procedure.
• Your surgeon will make several smaller incisions in your chest (for minimally invasive surgery) or one longer incision in the right part of your chest near the breastbone (for traditional, open-chest surgery).
• Your surgeon will repair or replace your damaged mitral valve.
• The cardiac team will remove you from the bypass machine, ensure your heart is functioning correctly and close your incision.

Recovery from mitral valve repair or replacement looks different for each patient. A typical recovery takes four to eight weeks, but recovery time varies depending on the type of surgery you have and your general health. Recovering from minimally invasive surgery is quicker than recovering from traditional open-heart surgery.

After the operation, you will spend a day or more in a cardiac intensive care unit (ICU) to monitor your stability before being moved to a general hospital room for a few days. While staying at the hospital, you will work to gradually increase physical activity until our cardiac team determines you are ready to go home. You will receive instructions on pain and symptom management, when to take your medications, and how to clean the incision site.

After any valve surgery, your cardiologist may recommend outpatient cardiac rehabilitation for exercise, nutrition, education, and support.